Valuing the economic consequences of work injury and illness: a comparison of methods and findings

Do employees' work schedules put them at-risk? The role of shift scheduling and holidays in predicting near miss and incident likelihood

INTRODUCTION

Using crew scheduling and injury incident data from a Fortune 500 manufacturing company, this study analyzed the effect of consecutive shifts and shifts near holidays on near misses and incidents.

METHODS

Logistic regressions were conducted with consecutive workdays, days near holidays, and time of shift as predictors of incident and near miss outcomes.

RESULTS

The logistic regression analysis indicated that working consecutive day shifts increases the probability of an incident occurring, with the fourth consecutive shift resulting in the most risk. The consecutive shift pattern did not replicate to employees working the night shift. However, the first and second shifts when transferring to a night schedule appear to have a greater chance of incident. Shifts near holidays did not have a significantly higher risk than other shifts.

PRACTICAL APPLICATION

The current research suggests that organizations can use similar analytic techniques to determine if shift scheduling might be related to increased risk and allocate resources to mitigate hazards during those peak probability shifts.

Show you the money – firms investing in worker safety have better financial performance: insights from a mapping review

Purpose

This study aims to (1) investigate the association between companies' investment in occupational safety and their financial performance and (2) discuss the importance of occupational safety to overall performance.

Design/methodology/approach

Occupational safety is often considered to be a practice that can yield suboptimal return on investment. However, it is not known whether this belief is substantiated by evidence. A mapping review of the eligible research literature (N = 36) regarding firms' investment in occupational safety and their financial performance, published between 1945 and2018, was carried out in the Web of Science database.

Findings

By dispelling myths regarding return on investment associated with occupational safety, the findings of this study underscore financial gains firms can obtain by promoting occupational safety measures in their organizations.

Originality/value

These issues are important because they can help policymakers understand the pressures companies face in terms of occupational safety and financial performance sustainability.

Labour accidents and financial performance: empirical analysis of the type of relationship in the Spanish context

This article performs empirical research and finds a negative relationship between accidents in the workplace and financial performance. The relationship is stronger and more persistent for performance 1 year ahead than for the current year. We find no significant evidence of curvilinear U-shaped or inverted U-shaped relationships. Results are strong across different industries and samples, variable definitions and model specifications. The study contributes to the scarce extant research with reliable data and samples of a wide span of industries. The study also contributes methodologically with refined analyses of the curvilinear relationship and providing robust widespread inference for a large number of industries.

Determinants of occupational injuries among building construction workers in Kampala City, Uganda

Background

Globally, about 1000 people die and close to 860,000 people sustain injury at work daily. Injury prevention and control require contextual evidence, although most studies in Uganda have focused on general causes. Factors associated with occupational injuries among building construction workers were assessed in this study.

Methods

A cross-sectional study among building construction workers was conducted in Kampala, Uganda. A standardized semi-structured questionnaire was used to collect data. Three hundred nineteen (319) participants were randomly and proportionately selected from 57 construction sites. Descriptive statistics were used to describe the variables while generalized linear modeling was used to estimate the crude/adjusted prevalence ratios.

Results

The prevalence of occupational injuries was 32.4%. Most injuries, approximately 70% occurred among nightshift workers. Age of ≤24 years (APR: 2.09 CI: 1.20–3.65, P = 0.009); daily income in or above the second quartile−USD ≥3.2 (APR: 1.72, CI: 1.06–2.80, P = 0.028); job dissatisfaction (APR: 1.63, CI: 1.17–2.27, P = 0.004); job stress (APR: 1.72, CI: 1.22–2.41, P = 0.004); poor safety environment (APR: 1.51, CI: 1.10–2.05, P = 0.009); PPE provision (APR: 1.47, CI: 1.05–2.05, P = 0.02) and routine use of PPE (APR: 0.57, CI: 0.34–0.95, P = 0.03) were significantly associated with occupational injuries.

Conclusion

There was a relatively high prevalence of injuries mostly resulting from cuts and mostly suffered on night duty. Upper and lower extremities were the most hurt parts of the body during injury leading to loss of a substantial number of productive days. This could affect the health and wellbeing of construction workers. Most of the factors significantly associated with occupational injuries are modifiable thus an opportunity to address the problem. Efforts towards integrating education for behaviour change, advocacy and training workers to demand for their rights to safe and protection at work and legislation enforcement can help reduce occupational injury occurrence.

Coverage Gaps and Cost-Shifting for Work-Related Injury and Illness: Who Bears the Financial Burden?

The heavy economic burden of work-related injury/illness falls not only on employers and workers' compensation systems, but increasingly on health care systems, health and disability insurance, social safety net programs, and workers and their families. We present a flow diagram illustrating mechanisms responsible for the financial burden of occupational injury/illness borne by social safety net programs and by workers and their families, due to cost-shifting and gaps in workers' compensation coverage. This flow diagram depicts various pathways leading to coverage gaps that may shift the burden of occupational injury/illness-related health care and disability costs ultimately to workers, particularly the most socioeconomically vulnerable. We describe existing research and important research gaps linked to specific pathways in the flow diagram. This flow diagram was developed to facilitate more detailed and comprehensive research into the financial burden imposed by work-related injury/illness, in order to focus policy efforts where improvement is most needed.

Finding causation in occupational fatalities: A latent class analysis

BACKGROUND

The method "Learning by mistakes" was developed in Italy to conduct occupational injury investigations and to collect information on the genesis of injuries. The aim is to analyze data classified with this method in order to identify patterns among the factors contributing to injury dynamics.

METHODS

Data regarding 673 factors, corresponding to 354 occupational fatalities that occurred in the Piedmont region (north-west of Italy) during 2005-2014 were considered. Latent Class Analysis (LCA) was applied to find patterns among these factors.

RESULTS

The eight-class model was selected. Most of the factors fell in the class "Fall from height or vehicle rollover due to incorrect practice" (40.56%) while the remaining factors where heterogeneously distributed in the other classes.

CONCLUSIONS

All the classes found allow for a logical interpretation. Systematic use of LCA could aid in uncovering new, unexpected patterns of factors not otherwise detectable by analysis of the single fatal accident.

Financial impact of injury in older workers: use of a national retrospective e-cohort to compare income patterns over 3 years in a universal injury compensation scheme

OBJECTIVE

The study aims to quantify the impact of injury on the financial well-being of older workers. The hypothesis was that injured older workers have substantially reduced income from work following injury, but that New Zealand's (NZ) universal injury compensation scheme mitigates the difference for total income.

DESIGN, SETTING AND PARTICIPANTS

An e-cohort of 617 722 workers aged 45-64 years old was created using de-identified linked administrative data in NZ's Integrated Data Infrastructure. Person-level data from numerous government agencies were used to compare 21 639 with an injury-related entitlement claim in 2009 with the remaining 596 133. Event date was the date of injury, or for the comparison group, a randomly selected date in 2009.

PRIMARY AND SECONDARY OUTCOME MEASURES

Geometric mean ratios (GMRs) were used to compare income from work and total income from all taxable sources between those injured and the comparison group. Adjusted GMRs estimated income differences up to 36 months following the event date.

RESULTS

Differences in total income increased over time. In the third year, those injured received 6.7% less (adjusted GMR 0.933 (95% CI 0.925 to 0.941)) than the comparison group, equivalent to an average loss of $NZ2628. Restricting to income from work, those injured received 29.2% less than the comparison group at 3 years (adjusted GMR 0.708 (95% CI 0.686 to 0.730)). For both men and women, those injured at 45-49 years consistently had the greatest relative income loss compared with those aged 50-54, 55-59 or 60-64 years.

CONCLUSIONS

Although the substantial impacts of injury on income were mainly mitigated by public income transfers, relative losses in income in those aged 45-64 years increased in the 3 years following injury. Policies focused on adequate compensation and reducing the time away from employment could reduce these financial impacts in older workers.

Pre-injury job characteristics and return to work among injured workers in South Korea: differences by socio-demographic and injury-related characteristics

PURPOSE

This study examined the effect of pre-injury job characteristics on the odds of RTW outcomes for specific socio-demographic and injury-related characteristics among injured workers in South Korea.

METHODS

This study employed first-wave data for 1993 participants from the Panel Study of Workers' Compensation Insurance. A two-step cluster analysis was conducted to profile pre-injury job characteristics, including monthly wages, length of service, company size, contract type, and working hours. For each subsample selected by the characteristics of the independent variables, multinomial logistic regression analyses were performed to predict the odds ratio for being unemployed or working in a new firm versus returning to the pre-injury job, depending on cluster membership.

RESULTS

Two clusters were identified with pre-injury job characteristics. Workers in the unstable employment cluster were more likely than were workers in the stable employment cluster to be unemployed or work in a new firm rather than return to the pre-injury job; this held for all socio-demographic and injury-related characteristics.

CONCLUSIONS

Our results showed a need to develop differential RTW strategies for injured workers in insecure jobs at the time of injury. Implications for rehabilitation Policymakers and rehabilitation practitioners need to take into account not only socio-demographic or injury-related characteristics but also working conditions at the time of injury when designing return-to-work programs for injured workers in South Korea. Injured employees in poor working conditions are relatively more vulnerable in the return-to-work process and deserve special attention and supports from the Korean government. The Korean government needs to review return-to-work policies for injured workers in unstable employment environment in the context of employment relationships rather than individual characteristics.

A systematic literature review of the effectiveness of occupational health and safety regulatory enforcement

BACKGROUND

We aimed to determine the strength of evidence on the effectiveness of legislative and regulatory policy levers in creating incentives for organizations to improve occupational health and safety processes and outcomes.

METHODS

A systematic review was undertaken to assess the strength of evidence on the effectiveness of specific policy levers using a "best-evidence" synthesis approach.

RESULTS

A structured literature search identified 11,947 citations from 13 peer-reviewed literature databases. Forty-three studies were retained for synthesis. Strong evidence was identified for three out of nine clusters.

CONCLUSIONS

There is strong evidence that several OHS policy levers are effective in terms of reducing injuries and/or increasing compliance with legislation. This study adds to the evidence on OHS regulatory effectiveness from an earlier review. In addition to new evidence supporting previous study findings, it included new categories of evidence-compliance as an outcome, nature of enforcement, awareness campaigns, and smoke-free workplace legislation. Am. J. Ind. Med. 59:919-933, 2016. © 2016 Wiley Periodicals, Inc.

The attributable annual health costs of U.S. occupational lead poisoning

BACKGROUND

U.S. occupational lead standards have not changed for decades, while knowledge about lead's health effects has grown substantially.

OBJECTIVE

The objective of this analysis was twofold: to estimate the attributable annual societal costs of health damages associated with occupationally lead-exposed U.S. workers and, more broadly, to develop methods for a fuller valuation of health damages.

METHODS

I combined data voluntarily reported to NIOSH on the number of highly exposed workers with published literature on the health effects of lead in adults to estimate the potential health benefits of lowering the U.S. occupational limit. I developed simple algorithms for monetizing more fully both the direct medical and indirect (productivity) damages associated with those high lead exposures.

RESULTS

I estimated direct medical costs of $141 million (2014US$) per year for 16 categories of health endpoints, and combined direct and indirect costs of over $392 million (2014US$) per year for the 10,000 or so U.S. workers with high occupational lead exposures.

CONCLUSIONS

Reducing allowable occupational lead limits produces annual societal benefits of almost $40,000 per highly exposed worker. Given underreporting of actual exposures and the omission of important health effects, this is likely a severe underestimate.

Economic consequences of workplace injuries in the United States: Findings from the National Longitudinal Survey of Youth (NLSY79)

BACKGROUND

This study explored economic consequences of work-related injuries using a longitudinal data source.

METHODS

Data were from the National Longitudinal Survey of Youth, 1979 cohort (n = 12,686). Short-term consequences were measured when the injury was reported. "Difference-in-differences" approach was applied to estimate income and wealth disparities between injured and non-injured workers before and after injury. Fixed effects models were used to identify variations over time.

RESULTS

The annual earnings growth was $3,715 (in 2000 dollars) less for workers with DAFW injury and $1,152 less for workers with NDAFW injury compared to non-injured workers during a 10-year follow-up. Lost wages and disability following injury contributed to income loss for injured workers, but the loss was moderated by union membership. After controlling for confounders, income disparities persisted, but family wealth differences did not.

CONCLUSIONS

Occupational injuries exacerbate income inequality. Efforts to reduce such disparities should include workplace safety and health enforcement.

Musculoskeletal disorders and associated healthcare costs among family members of injured workers

BACKGROUND

Research has infrequently looked beyond the injured worker when gauging the burden of occupational injury.

OBJECTIVES

We explored the relationship between occupational injury and musculoskeletal disorders (MSDs) among family members of injured workers.

DATA AND METHODS

We used 2005 and 2006 Truven Health Analytics databases, which contain information on workers' compensation and family healthcare claims. We used descriptive analyses, and negative binomial and two-part models.

RESULTS

Family members of severely injured workers had a 15% increase in the total number of MSD outpatient claims and a 34% increase in the mean cost of MSD claims compared to family members of non-severely injured workers within 3 months after injury. Extrapolating cost results to the national level implies that severe occupational injury would be associated with between $29 and $33 million additional cost of family member outpatient MSD claims.

CONCLUSION

Occupational injury can impose a formerly unrecognized health burden on family members of injured workers.

Compensation benefits in a population-based cohort of men and women on long-term disability after musculoskeletal injuries: costs, course, predictors

OBJECTIVES

The aim of this study is to assess costs, duration and predictors of prolonged compensation benefits by gender in a population characterised by long-term compensation benefits for traumatic or non-traumatic musculoskeletal injuries (MSIs).

METHODS

This study examined 3 years of data from a register-based provincial cohort including all new allowed long-term claims (≥3 months of wage replacement benefits) related to neck/shoulder/back/trunk/upper-limb MSIs in Quebec, Canada, from 2001 to 2003 (13,073 men and 9032 women). Main outcomes were compensation duration and costs. Analyses were carried out separately for men and women to investigate gender differences. An extended Cox model with Heaviside functions of time was used to account for covariates with time-varying effects.

RESULTS

Male workers experienced a longer compensation benefit duration and higher median costs. At the end of follow-up, 3 years postinjury, 12.3% of men and 7.3% of women were still receiving compensation benefits. Effects of certain predictors (e.g., income, injury site or industry) differed markedly between men and women. Age and claim history had time-varying effects in the men's and women's models, respectively.

CONCLUSIONS

Knowing costs, duration and predictors of long-term compensation claims by gender can help employers, decision makers and rehabilitation specialists to identify at-risk workers and industries to engage them in early intervention and prevention programmes. Tailoring parts of long-term disability prevention and management efforts to men's and women's specific needs, barriers and vulnerable subgroups, could reduce time on benefits among both male and female long-term claimants.

Accidents at work and costs analysis: a field study in a large Italian company

Accidents at work are still a heavy burden in social and economic terms, and action to improve health and safety standards at work offers great potential gains not only to employers, but also to individuals and society as a whole. However, companies often are not interested to measure the costs of accidents even if cost information may facilitate preventive occupational health and safety management initiatives. The field study, carried out in a large Italian company, illustrates technical and organisational aspects associated with the implementation of an accident costs analysis tool. The results indicate that the implementation (and the use) of the tool requires a considerable commitment by the company, that accident costs analysis should serve to reinforce the importance of health and safety prevention and that the economic dimension of accidents is substantial. The study also suggests practical ways to facilitate the implementation and the moral acceptance of the accounting technology.

Effects of residential location and work-commuting on long-term work disability

PURPOSE

Little is known about the independent effect of workers' residential location and work-commuting on their long-term disability due to work-related injuries. We examined 149,110 incident claims while adjusting for multiple risk factors in a large, population-based sample of Washington State workers' compensation State Fund claims during 2002-2008.

METHODS

Claimants' residential addresses were geocoded with census tract and aggregated into four category classification of the Rural Urban Commuting Area Codes (RUCAs) which takes into account for tract-level work-commuting. We used logistic regressions to assess the association between RUCAs and whether or not a person was off work for more than 180 days due to injury; Quantile regressions to predict various percentiles of cumulative lost workdays by RUCAs.

RESULTS

Compared to those who live in the Urban Core, workers in other areas experienced longer average paid time loss days due to work-related injury. The association between residential location and long-term disability was significant, odds ratio (OR) 1.19 (95 % confidence interval (CI) 1.11-1.27) for residents of Small Town and Isolated Rural and OR 1.17 (95 % CI 1.12-1.22) for those of Sub Urban, and persisted after controlling for injury nature, socio-demographic, employment-related, and claim administrative characteristics. The impact of residential location and work-commuting elevated as the duration of disability increased.

CONCLUSIONS

This study shows that residential location and work-commuting has a significant and time-varying impact on duration of work disability. Workers living in Sub Urban and Small Town and Isolated Rural areas represent a particularly vulnerable group with respect to risk of long-term work disability.

Health care costs and the socioeconomic consequences of work injuries in Brazil: a longitudinal study

Work injuries are a worldwide public health problem but little is known about their socioeconomic impact. This prospective longitudinal study estimates the direct health care costs and socioeconomic consequences of work injuries for 406 workers identified in the emergency departments of the two largest public hospitals in Salvador, Brazil, from June through September 2005. After hospital discharge workers were followed up monthly until their return to work. Most insured workers were unaware of their rights or of how to obtain insurance benefits (81.6%). Approximately half the cases suffered loss of earnings, and women were more frequently dismissed than men. The most frequently reported family consequences were: need for a family member to act as a caregiver and difficulties with daily expenses. Total costs were US$40,077.00 but individual costs varied widely, according to injury severity. Out-of-pocket costs accounted for the highest proportion of total costs (50.5%) and increased with severity (57.6%). Most out-of-pocket costs were related to transport and purchasing medicines and other wound care products. The second largest contribution (40.6%) came from the public National Health System - SUS. Employer participation was negligible. Health care funding must be discussed to alleviate the economic burden of work injuries on workers.

Incidence and costs of family member hospitalization following injuries of workers' compensation claimants

BACKGROUND

The consequences of occupational injuries for the health of family members have rarely been studied. We hypothesized that non-fatal occupational injury would increase the incidence and costs of hospitalization among workers' families, and that family members of severely injured workers would be likely to experience greater increases in hospitalizations than family members of non-severely injured workers.

DATA AND METHODS

We used the MarketScan databases from Thomson Reuters for 2002-2005, which include workers' compensation and inpatient medical care claims data for injured workers' families. We used a before-after analysis to compare the odds and costs of family hospitalization 3 months before and after the index occupational injury among 18,411 families. Severe injuries were defined by receipt of indemnity payments and at least 7 days of lost work. Family hospitalizations were measured by the incidence of hospitalization of at least one family member.

RESULTS

Among families of all injured workers, the odds of at least one family member being hospitalized were 31% higher [95% confidence intervals (CI) = 1.11-1.55] in the 3 months following occupational injury than in the 3 months preceding injury. Among the families of severely injured workers, the odds of hospitalization were 56% higher [95% CI = 1.05-2.34] in the 3 months following injury. Hospitalization costs were found to rise by approximately the same percentage as hospitalization incidence.

CONCLUSION

The impact of occupational injury may extend beyond the workplace and adversely affect the health and inpatient medical care use of family members.

Occupational injury in America: An analysis of risk factors using data from the General Social Survey (GSS)

INTRODUCTION

Although much is known about the distribution of occupational injury in terms of various job and employment factors, considerably less is known about other possible risk factors, particularly those involving psychosocial and organizational factors. These factors have not been emphasized in most injury surveillance systems or large scale, population based surveys.

METHOD

In this study, data from the 2002 General Social Survey (GSS) and NIOSH Quality of Work Life (QWL) module were used to examine the risk of occupational injury in terms of socio-demographic factors, employment characteristics, and organizational factors.

RESULTS

The most informative results were obtained from Poisson regression analyses, which identified race, occupational category, and work-family interference as risk factors, and safety climate and organizational effectiveness as protective factors for occupational injury. These results provide guidance for targeting interventions and protective measures to curtail occupational injury in the United States.

Legal sequelae of occupational back injuries: a longitudinal analysis of Missouri judicial records

STUDY DESIGN

Telephone survey and longitudinal analysis of judicial database for cohort of worker's compensation (WC) claimants in Missouri.

OBJECTIVE

To compare legal difficulties experienced by African American and white WC claimants presettlement versus postsettlement.

SUMMARY OF BACKGROUND DATA

Retrospective studies suggest that workers with occupational back injuries experience financial and personal duress after claim settlement. This study examined these issues by comparing financial and domestic court actions for the 5-year presettlement against 5-year postsettlement. Sociodemographic differences also were examined.

METHODS

Missouri judicial records were reviewed for African American (n = 580) and non-Hispanic white (n = 892) WC claimants to determine the frequency with which four types of cases occurred: general financial, domestic financial, residence financial, and domestic behavior. Average annual level of judicial activity during the 5 years before claim settlement was compared to activity for each of five postsettlement years; significance of change was evaluated with univariate and multivariate repeated measures analyses.

RESULTS

Statistically significant (P < 0.001) postsettlement increases in legal cases were noted for each of the four categories of cases. There were significant interactions between race and time for general financial and domestic financial cases. A significant interaction between age and time occurred for general financial cases. Significant three-way interactions (race × income change × time) emerged for general and domestic financial cases.

CONCLUSION

The results confirm that workers with occupational back injuries, especially African American and younger adults, encounter long-term financial and domestic duress that appears to escalate with each passing year after claim settlement. This pattern suggests that short-term studies underestimate postsettlement difficulties, particularly among selected demographic cohorts.

Predictors and economic burden of serious workplace falls in health care

AIMS

To examine the demographic and workplace risk factors of serious falls and associated economic burden in Canadian health care workers.

METHODS

Fall injury data during 2005-2008 from a workplace health and safety surveillance system were linked with workers' compensation claims and payroll records. The costs for treatment and wage loss and days lost for accepted time-loss claims were calculated. Demographic and work-related factors were identified to distinguish the risk for more serious falls from less serious falls.

RESULTS

Nine hundred and thirty-eight fall injury claims were captured among 48 519 full-time equivalent workers. Workers >60 years, part time or employed in the long-term care sector sustained a higher proportion of serious falls (>70%). Over 75% of falls were serious for care aides, facility support service workers and community health workers. In the multivariate analysis, the risk of serious falls remained higher for workers in the long-term care sector [odds ratio (OR) 1.71; P < 0.05] compared with those in acute care and for care aides (OR 1.72; P < 0.05), facility support service workers (OR 2.58; P < 0.01) and community health workers (OR 3.61; P < 0.001) compared with registered nurses (RNs). The median number of days lost was higher for females, long-term care workers, licensed practical nurses and care aides. Females, long-term care workers, RNs, licensed practical nurses, care aides and maintenance workers had the most costly falls.

CONCLUSIONS

Reducing work-related serious fall injuries would be expected to bring about significant benefits in terms of reduced pain and suffering, improved workplace productivity, reduced absenteeism and reduced compensation costs.

Characteristics of national registries for occupational diseases: international development and validation of an audit tool (ODIT)

Background-

The aim of the study was to develop quality indicators that can be used for quality assessment of registries of occupational diseases in relation to preventive policy on a national level. The research questions were: 1. Which indicators determine the quality of national registries of occupational diseases with respect to their ability to provide appropriate information for preventive policy? 2. What are the criteria that can distinguish low quality from high quality?

Methods-

First, we performed a literature search to assess which output of registries can be considered appropriate for preventive policy and to develop a set of preliminary indicators and criteria. Second, final indicators and criteria were assessed and their content validity was tested in a Delphi study, for which experts from the 25 EU Member States were invited.

Results-

The literature search revealed two different types of information output to be appropriate for preventive policy: monitor and alert information. For the evaluation of the quality of the monitor and alert function we developed ten indicators and criteria. Sixteen of the twenty-five experts responded in the first round of the Delphi study, and eleven in the second round. Based on their comments, we assessed the final nine indicators: the completeness of the notification form, coverage of registration, guidelines or criteria for notification, education and training of reporting physicians, completeness of registration, statistical methods used, investigation of special cases, presentation of monitor information, and presentation of alert information. Except for the indicator "coverage of registration" for the alert function, all the indicators met the preset requirements of content validity.

Conclusion-

We have developed quality indicators and criteria to evaluate registries for occupational diseases on the ability to provide appropriate information for preventive policy on a national level. Together, these indicators form a tool which can be used for quality improvement of registries of occupational diseases.

Estimation of health-care costs for work-related injuries in the Mexican Institute of Social Security

BACKGROUND

Data on the economic consequences of occupational injuries is scarce in developing countries which prevents the recognition of their economic and social consequences. This study assess the direct heath care costs of work-related accidents in the Mexican Institute of Social Security, the largest health care institution in Latin America, which covered 12,735,856 workers and their families in 2005.

METHODS

We estimated the cost of treatment for 295,594 officially reported occupational injuries nation wide. A group of medical experts devised treatment algorithms to quantify resource utilization for occupational injuries to which unit costs were applied. Total costs were estimated as the product of the cost per illness and the severity weighted incidence of occupational accidents.

RESULTS

Occupational injury rate was 2.9 per 100 workers. Average medical care cost per case was $2,059 USD. The total cost of the health care of officially recognized injured workers was $753,420,222 USD. If injury rate is corrected for underreporting, the cost for formal injured workers is 791,216,460. If the same costs are applied for informal workers, approximately half of the working population in Mexico, the cost of healthcare for occupational injuries is about 1% of the gross domestic product.

CONCLUSIONS

Health care costs of occupational accidents are similar to the economic direct expenditures to compensate death and disability in the social security system in Mexico. However, indirect costs might be as important as direct costs.

The prevalence and workplace costs of adult attention deficit hyperactivity disorder in a large manufacturing firm

BACKGROUND

Little is known about the effects of adult attention deficit hyperactivity disorder (ADHD) on work performance or accidents-injuries.MethodA survey was administered in 2005 and 2006 to employees of a large manufacturing firm to assess the prevalence and correlates of adult ADHD. Respondents (4,140 in 2005, 4,423 in 2006, including 2,656 in both surveys) represented 35-38% of the workforce. ADHD was assessed with the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS), a validated screening scale for DSM-IV adult ADHD. Sickness absence, work performance and workplace accidents-injuries were assessed with the WHO Health and Work Performance Questionnaire (HPQ).

RESULTS

The estimated current prevalence (standard error) of DSM-IV ADHD was 1.9% (0.4). ADHD was associated with a 4-5% reduction in work performance (chi12=9.1, p=0.001), a 2.1 relative-odds of sickness absence (chi12=6.2, p=0.013), and a 2.0 relative-odds of workplace accidents-injuries (chi12=5.1, p=0.024). The human capital value (standard error) of the lost work performance associated with ADHD totaled USD 4,336 (676) per worker with ADHD in the year before interview. No data were available to monetize other workplace costs of accidents-injuries (e.g. destruction of equipment). Only a small minority of workers with ADHD were in treatment.

CONCLUSIONS

Adult ADHD is a significantly impairing condition among workers. Given the low rate of treatment and high human capital costs, in conjunction with evidence from controlled trials that treatment can reduce ADHD-related impairments, ADHD would seem to be a good candidate for workplace trials that evaluate treatment cost-effectiveness from the employer's perspective.

Social and economic consequences of workplace injury: a population-based study of workers in British Columbia, Canada

BACKGROUND

Existing research suggests that workplace injuries can have significant economic and social consequences for workers; but there are no quantitative studies on complete populations.

METHODS

The British Columbia Linked Health Database (BCLHD) was used to examine 1994 injured workers who lost work time due to the injury (LT) and a group of injured individuals who did not lose time after their injuries (NLT). Three outcomes were explored: (1) residential change, (2) marital instability, and (3) social assistance use. Logistic regression adjusted for several individual and injury characteristics.

RESULTS

LTs were more likely to move and collect income assistance benefits, and less likely to experience a relationship break-up than the NLTs. LTs off work for 12 or more weeks were more likely to receive income assistance than LTs off for less time.

CONCLUSIONS

The increased risk suggests that the long-term economic consequences of disabling work injury may not be fully mitigated by workers compensation benefits.

Prognostic Factors of Long-Term Disability in a Workers?? Compensation System

OBJECTIVE

We identified predictive factors of long-term disability in new workers' compensation claims to guide secondary prevention research and target interventions for high-risk claims.

METHODS

Workers with 4 or more days of work disability resulting from workplace injuries were followed for approximately 6 years in a population-based retrospective inception cohort study of 81,077 workers.

RESULTS

Predictors of long-term disability included delay between injury and first medical treatment, older age, construction industry, logging occupation, longer time from medical treatment to claim filing, back injury, smaller firm size, female gender, higher unemployment rate, and having dependents. We used logistic and quantile regression to investigate predictors of disability. These models produced consistent information regarding predictors.

CONCLUSION

These factors can be used to identify jobs or workers at increased risk for long-term disability that warrant prevention intervention.

Acidentes de trabalho: custos previdenciários e dias de trabalho perdidos

OBJETIVO: Estimar a contribuição de benefícios concedidos por acidentes de trabalho dentre o total de benefícios relacionados com a saúde da Previdência Social, focalizando os custos conforme o tipo de benefício, e o impacto sobre a produtividade relativa a dias perdidos de trabalho. MÉTODOS: Utilizam-se registros dos despachos de benefícios do Sistema Único de Benefícios do Instituto Nacional de Seguridade Social da Bahia, em 2000. Acidentes de trabalho foram definidos com o diagnóstico clínico para Causas Externas, Lesões e Envenenamentos (SS-00 a T99) da Classificação Internacional de Doenças 10ª Revisão, e o tipo de benefício que distingue problemas de saúde ocupacionais e não ocupacionais. RESULTADOS: Foram estudados 31.096 benefícios concedidos por doenças ou agravos à saúde, dos quais 2.857 (7,3%) eram devidos a acidentes de trabalho. Maiores proporções foram estimadas entre os trabalhadores da indústria da transformação e construção/eletricidade/gás, 18% do total dos benefícios. Os custos com os benefícios para acidentes de trabalho foram estimados em R$8,5 milhões, com aproximadamente meio milhão de dias perdidos de trabalho no ano. CONCLUSÕES: Apesar do conhecimento de que esses dados são sub-enumerados, e restritos aos trabalhadores que conseguiram receber benefícios relacionados com a saúde, os achados revelam o grande impacto sobre a produtividade e o orçamento do Instituto Nacional de Previdência Social de agravos reconhecidos como evitáveis, reforçando a necessidade de sua prevenção.

Costs and compensation of work-related injuries in British Columbia sawmills

OBJECTIVE

To estimate the costs of work-related injury in a cohort of sawmill workers in British Columbia from the perspective of the workers' compensation system.

METHODS

Hospital discharge records were extracted from 1989 to 1998 for a cohort of 5786 actively employed sawmill workers. A total of 173 work-related injury cases were identified from these records using the International classification of diseases-ninth revision (ICD-9) external cause of injury codes and the responsibility of payment schedule. Workers' compensation records were extracted and matched with hospital records by dates and ICD-9 diagnosis codes. All costs were converted into 1995 constant Canadian dollars using the Provincial General Consumer Price Index for the non-healthcare costs and Medical Consumer Price Index for the healthcare costs. A 5% discounting rate was applied to adjust for the time value of money. For the uncompensated cases, costs were imputed from the compensated cases using the median cost for a similar nature of injury.

RESULTS

370 hospitalisation events due to injury were captured, and by either of the two indicators (E Codes or payment schedules), 173 (47%) hospitalisation events due to injury, were identified as work related. The median healthcare cost was 4377 dollars and the median non-healthcare cost was 16,559 dollars for a work-related injury. The median non-healthcare and healthcare costs by injury were falls, 19,978 dollars and 5185 dollars; struck by falling object, 32,398 dollars and 8625 dollars; struck against, 12,667 dollars and 5741 dollars; machinery related, 26,480 dollars and 6643 dollars; caught in or between, 24,130 dollars and 4389 dollars; and overexertion, 7801 dollars and 2710 dollars. The total cost was 10,374,115 dollars for non-healthcare and 1,764,137 dollars for healthcare. The compensation agency did not compensate 874,871 dollars (8.4%) of the non-healthcare costs and 200,588 dollars (11.4%) of the healthcare costs.

CONCLUSION

Eliminating avoidable work-related injury events can save valuable resources.

Estimation of reduced life expectancy from serious occupational injuries in Taiwan

This study assesses the loss of life expectancy and potential working life in Taiwan, between 1986 and 2000, from various types of occupational accidents resulting in mortality or permanent disability. The databases on occupational mortality and permanent disability were obtained from the Bureau of Labor Insurance, with this information then being linked to national death registry data to construct the survival function. A Monte Carlo simulation method was subsequently used to extrapolate the survival rate for up to 600 months, to derive the life expectancy for different types of occupational accidents leading to permanent disability (n=81,249). Based upon the life table for each calendar year, the life expectancy lost by age-gender cohort was also estimated for cases of mortality (n=20,001). In those cases resulting in permanent occupational disability, variations in the expected years of life lost (EYLL) were demonstrated by different occupational injuries, ranging from 7.4 to 13.6 years per case. The overall EYLL through permanent occupational disability is found to be almost identical to that of occupational mortality, with a ratio of 1.04:1. We conclude that permanent disability resulting from occupational injuries has a significant impact on society as a whole.

Cost of Compensated Injuries and Occupational Diseases in Agriculture in Finland

Although agriculture is one of the most hazardous industries, the costs of agricultural injuries and illnesses are not well known. This study aimed to determine the cost burden from compensated injuries and occupational diseases in Finnish agriculture using workers compensation records. The incidence rates in 1996 were 7.4/100 for injuries and 0.61/100 for occupational diseases. Men had a higher risk of injury (RR = 1.89; 95% CI: 1.81-1.97), but a lower risk of an occupational disease (RR = 0.68; 95% CI: 0.60-0.78), compared to women. The total cost burden was 75 (Euros) per person in 1983, increasing to 215 in 1999. The total insurance cost in 1996 was 23.5 million consisting of medical care (16%), per diem (lost time compensation within one year from the incident) (37%), pension (lost time compensation after one year from the incident) (23%), survivors pension (3%), impairment allowance (7%), rehabilitation (6%), and other costs (9%). The total cost was 0.7% of the national gross farm income and 2.2% of the net farm income. The mean cost of 1996 cases was 1340 for injuries and 6636 for occupational diseases. Injuries represented 92% of the claims and 71% of the total costs. Occupational diseases represented 8% of the claims and 29% of the costs. Twenty percent of the most severe claims represented 79.5% of the total insurance costs. Injuries and occupational diseases result in significant costs in agriculture. Lost time was the largest cost item. Overall, injuries were more costly than occupational diseases. This study indicates that the 20%-80% rule applies to agricultural injury and illness costs, and from the cost standpoint, it is important to focus prevention efforts on the most severe incidents.

Prevention of injuries at work: the role of the occupational physician

OBJECTIVES

To highlight the role of occupational physician (OP) in occupational injuries (OI) prevention and management. To suggest an approach beyond traditional focus on descriptive epidemiology, engineering interventions, administrative aspects of OI prevention. To promote a person- and enterprise-tailored approach, entailing greater attention to human factors and to practical problems of the specific workplace, with a call to a leading role played by OP.

METHODS AND RESULTS

Analysis of the literature on the broader topic of OI prevention revealed thousands of publications; however, only a handful of them mention or describe the participation of OP in OI prevention. While recognizing that literature search is not the proper and only way to appreciate the current role of OP in this field, therefore, it seems necessary to call OP to a stronger effort in prevention and management of OI, through the context of a comprehensive intervention in cooperation with managers, supervisors, safety personnel and workers, focusing on specific needs of each enterprise. The following areas of OP intervention were examined: risk assessment, health surveillance, management, scientific research and health education. Within each of these topics, possible contributions, methodologies, instruments available for the OP were discussed, taking into account the relevant literature. Pathways for practical applications were illustrated, e.g., OI data generation and analyses, predictors of OI, fitness for work, case management, team work, educational issues, first aid, suggestion for OP contribution in specific research questions.

CONCLUSIONS

OI continue to take a remarkable toll from individuals and society. New multidisciplinary interventions are needed to prevent OI. Focused activities at the single worksite with a central role from OP are definite options. OP is an effective interface between workforce and management and may offer, through a proactive approach, valuable practical and cultural contributions, while respecting technical and ethical guidelines of occupational health professionals.

Characterizing the Burden of Occupational Injury and Disease

OBJECTIVES

To review the literature on the burden of occupational disease and injury and to provide a comprehensive characterization of the burden.

METHODS

The scientific and governmental literature from 1990 to the present was searched and evaluated. Thirty-eight studies illustrative of the burden of occupational disease were reviewed for findings, methodology, strengths, and limitations.

RESULTS

Recent U.S. estimates of occupational mortality and morbidity include approximately 55,000 deaths (eighth leading cause) and 3.8 million disabling injuries per year, respectively. Comprehensive estimates of U.S. costs related to these burdens range between dollar 128 billion and dollar 155 billion per year. Despite these significant indicators, occupational morbidity, mortality, and risks are not well characterized in comparative burden assessments.

CONCLUSIONS

The magnitude of occupational disease and injury burden is significant but underestimated. There is a need for an integrated approach to address these underestimates.